To induce the Danbury Police Athlectic League to accept registration and
permit participation by the above named child, I hereby give my permission
and consent, agree to release, indemnify, and hold harmless the Danbury
PAL, its' officers, staff and representatives from any claims arising
from any inquiry to the above named minor. I hereby give my consent for
emergency care prescribed by the duly licensed Doctor of Medicine or Doctor
of Dentistry. This may be given under whatever conditions are necessary
to preserve life, limb or well-being of my dependant
I agree to pay all registration fees on timely basis. A fee of $25 will
be charged for each returned check.

By entering your name below constitutes an electronic signature
that is legal as if you actually signed this document with a pen.

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DATE

AFTER SUBMITTING THIS FORM, YOU WILL BE RE-DIRECTED TO A PAYMENT PAGE
THAT WILL GIVE YOU THE OPTION OF PAYING ONLINE OR PRINTING OUT A FORM TO
MAIL IN